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Mechanical ventilation for SARS The basics

Mechanical ventilation for SARS The basics. Charles Gomersall Dept of Anaesthesia & Intensive Care The Chinese University of Hong Kong Prince of Wales Hospital Version 1.0 April 2003. Configure Powerpoint.

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Mechanical ventilation for SARS The basics

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  1. Mechanical ventilation for SARSThe basics Charles GomersallDept of Anaesthesia & Intensive CareThe Chinese University of Hong KongPrince of Wales Hospital Version 1.0 April 2003

  2. Configure Powerpoint • If you have not already configured Powerpoint to advance slides using timings stop now and do so. • From Slide Show drop down menu select Set Up Show. In the Advance Slides option select Use timings, if present. Click OK. Click on the relevant button Already configured Stop

  3. Disclaimer • Although considerable care has been taken in the preparation of this tutorial, the author, the Prince of Wales Hospital and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from its use.

  4. The problem • Heterogenous involvement of lung • Normal compliance •  compliance • Overall:  compliance

  5. Inflates and deflates normally

  6. Inflates and deflates normally

  7. Inflates and deflates normally

  8. Inflates and deflates normally

  9. Inflates and deflates normally

  10. Inflates and deflates normally

  11. Hyperinflates Inflates and deflates normally

  12. Hyperinflates

  13. Hyperinflates

  14. Hyperinflates

  15. Hyperinflates

  16. Hyperinflates

  17. Hyperinflates Tidal opening and collapse

  18. Tidal opening and collapse

  19. Tidal opening and collapse

  20. Tidal opening and collapse

  21. Tidal opening and collapse

  22. Tidal opening and collapse

  23. Tidal opening and collapse

  24. Collapsed

  25. Collapsed

  26. Collapsed

  27. Collapsed

  28. Collapsed

  29. Collapsed

  30. The problem • Hyperinflated  risk of volutrauma • Recurrent opening and collapse  risk of shear injury • Some alveoli persistently collapsed  shunting

  31. The problem • Heterogenous involvement of lung • Normal compliance •  compliance • High risk of “barotrauma”

  32. Barotrauma & volutrauma • Unrestricted lungs • Pulmonary oedema at PAW of 45 cmH2O • Restricted lungs • No pulmonary oedema at same pressures

  33. The problem • Heterogenous involvement of lung • Normal compliance •  compliance • High risk of barotrauma • Large shunt • High oxygen requirement • Risk of oxygen toxicity

  34. Principles • Minimize FIO2 • SpO2 88-94%

  35. Principles • Minimize FIO2 • Low tidal volume and low inspiratory pressure • Start with 8ml/kg PBW and work down to 4-6 ml/kg

  36. Principles • Minimize FIO2 • Low tidal volume and low inspiratory pressure • Start with 8ml/kg PBW and work down to 4-6 ml/kg • Increase respiratory rate to maintain minute ventilation • Check for intrinsic PEEP

  37. Principles • Minimize FIO2 • Low tidal volume and low inspiratory pressure • Start with 8ml/kg PBW and work down to 4-6 ml/kg • Increase respiratory rate to maintain minute ventilation • Check for intrinsic PEEP • Allow PaCO2 to rise • Keep pH>7.3 if possible

  38. Principles • Minimize FIO2 • Low tidal volume and low inspiratory pressure • Start with 8ml/kg PBW and work down to 4-6 ml/kg • Increase respiratory rate to maintain minute ventilation • Check for intrinsic PEEP • Allow PaCO2 to rise • Keep pH>7.3 if possible • Sedation ± paralysis

  39. Practice • Start with FIO2=1.0 • Choose the mode that you and the other staff in your ICU are most familiar with Pressure control PRVC Volume control Before selecting a mode of ventilation download and printthe relevant algorithm for ventilating SARS patients Download

  40. Volume control • Measure patient’s height and calculate PBW • Set PEEP 6-12 cmH2O, I:E=1:2 • Start with VT=8 ml/kg PBW • At 1-2 hour intervals decrease VT by 1 ml/kg to a minimum of 4 ml/kg • Maintain 4-6 ml/kg • Every 4h and after each change measure Pplat, PEEPi, and pH Click here to continue

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